Trauma: Understanding the Misuse and True Definition of a Complex Psychological Concept

As a child, I was groomed and sexually molested by my stepfather. I’m now in counseling and am putting my life back together. My therapist says that experiences like mine are called “trauma.” But then I hear other people say they were “traumatized” because their sports team lost. Or that confronting their teen over failing grades was “traumatic.” They use the word for anything that’s stressful or that doesn’t go their way — instead of using it for instances of true harm. So what is trauma?

ANSWER:

Thank you for sharing such a personal and painful part of your story with us. What you experienced as a child was wrong and evil. We’re glad you’re working with a therapist to confront your trauma and take steps toward healing.

You’re right: People often overuse and misuse the word trauma. They seem to assume that any negative effect they experience must be trauma. What they likely don’t realize, though, is that there’s a difference between hurt and harm. And understanding that difference lays the groundwork for understanding the true definition of trauma.

The difference between hurt and harm

We all experience hurt in life. Such frustrations and struggles are a natural part of being human in a broken world — such as a favorite sports team losing or a child coming home with a bad report card. Harm, on the other hand, can cause lasting damage. And this is where the clinical definition of trauma starts to make more sense.

However, before we take a closer look at that clinical definition, we want to emphasize that we would never dismiss someone’s pain because of the words they use to describe it. As Christians who know Jesus as Lord and Savior, we are confident that God will, for those who follow Him, redeem everything that goes wrong because of sin — even disappointing moments that, strictly speaking, don’t affect wellbeing.

Until then, we weep with those who weep because we know the Lord has compassion for our frailty and that He sees our tears. We also commiserate together and look for humor in the annoyances and inconveniences that bring laughter to everyday life.

An overview of separating common language
from clinical accuracy

Our goal here is to offer an accurate, clinically based understanding of what trauma is and how to separate trauma from other difficult life experiences. Still, the topic is too complex to address everything in this small space. So, while we’ll cover the following areas, we also encourage readers to get the advice of a trained therapist for their specific questions.

• The value of talking to a counselor
• Why an accurate definition of trauma matters
• How trauma is clinically defined
• Four expressions of trauma exposure and response
• Using descriptive words instead of prescriptive words
• Examples of descriptive words
• How to know if you have trauma

What’s the value of talking to a counselor?

A trustworthy, objective counselor can help someone sort through life experiences and the impact of pop language to identify potential trauma. With that knowledge, they can assist the hurting individual to find solid footing for the healing process — either to address clinical trauma or learn healthy ways to manage life stress.

Call our professional and pastoral counselors for a free consultation at 1-855-771-HELP (4357). They can refer you to qualified counselors and Christian therapists in your area for continuing support.

Why does an accurate definition of trauma matter?

You probably are familiar with the saying, If everything is important, then nothing is important. The same principle applies to trauma: If people act like everything is traumatic, then nothing is traumatic.

The word trauma and various forms of the word (traumatic or traumatized) are, at times, tossed out flippantly in conversation to overstate the impact of certain relatively minor events. … These circumstances, though upsetting, embarrassing, or frustrating, are likely not going to cause lasting emotional distress. (Eliza Huie, Trauma Aware)

We see it in publications, social media, and news coverage, and we hear it seemingly everywhere: People talk about being traumatized by things that are upsetting but not life-threatening. At one time or another, we might even have joked about it. For example, we say, My drive to work this morning was so traumatizing! But what we mean is that we were annoyed by the extra traffic and arrived at the office late.

So why does it matter how trauma is defined? For two reasons:

• Misusing or overusing words has consequences.
• There is a difference between trauma and stress.

Stick with us while we explain.

Misusing or overusing words has consequences

When people claim that every difficulty or inconvenience in life is a major crisis, they undermine individuals who do experience life-threatening circumstances and need professional care.

Remember the lesson from the children’s story The Boy Who Cried Wolf? We’re not suggesting that someone who says they have suffered trauma is lying. However, if everything is considered traumatic, people might be more likely to minimize or ignore someone’s story of real trauma (as it’s clinically defined).

Most people would not mean to undermine someone in anguish. Still, if others consistently downplay truly critical situations, a person with clinical trauma might not get the help they need. To that point, psychologist Dr. Carla Manly says that using the word trauma for routine life experiences “can downgrade the seriousness of genuine trauma.”

When we dilute psychological terms such as trauma — applying weighty terminology to commonplace, everyday matters — we face the serious risk of minimizing mental health issues and the difficult experiences of those who suffer from them. (Have We Hit Peak Trauma?)

There is a difference between trauma and stress

Self-diagnosing common struggles as trauma falsely removes personal responsibility for how we react to basic life stress. We can easily see ourselves as victims instead of admitting that life can just be harsh and that we must take ownership of our mindset and responses. Dr. Laurel Shaler writes,

I am convinced that we must be cautious about mislabeling. If we identify any and everything that goes wrong in our lives as traumatic, we not only allow ourselves to be victimized by frustrations and hardships, but we reduce the meaning of trauma. (Reclaiming Sanity)

Psychologist Nick Haslam points out that over-defining trauma weakens coping behavior:

When we describe misfortune, sadness or even pain as trauma, we redefine our experience. Using the word “trauma” turns every event into a catastrophe, leaving us helpless, broken and unable to move on.

Again, we aren’t saying that life isn’t tough. Some circumstances leave us dissatisfied, disappointed, or even desperate — such as divorce, chronic illness, or losing a job. Our goal here is not to dismiss pain. Rather, we want to clarify the difference between common use of the word trauma and its clinical definition.

Some upsetting or disturbing situations … don’t necessarily qualify as trauma. … We want to remain balanced in our approach to becoming trauma aware. Not every distressing or upsetting event will result in traumatization. (Eliza Huie, Trauma Aware)

That leads us to the clinical definition of trauma.

What is the clinical definition of trauma?

Labeling an event as trauma requires exposure to actual or threatened death, serious injury, or sexual violence. An individual must have directly experienced a traumatic event (being part of it) or have personally seen it happen to someone else (not just watching events in some form of media).

That said, trauma can be tricky to explain because it has two parts: Exposure and response (the event and its impact). Together, they can create four combinations of exposure and response, which we’ll discuss in the next section.

In the meantime, here’s a quick explanation of exposure and response summarized from the Diagnostic and Statistical Manual of Mental Disorders. (Mental health professionals use the DSM-5-TR to diagnose and classify mental health disorders.)

Exposure to trauma

To be classified as trauma, an exposure (event) must be (1) a violent or accidental life-threatening act, or (2) a sexually violent act. (An accumulation of less violent events over time can also be classified as trauma, sometimes labeled complex trauma.)

Response to trauma exposure

To be classified as having a traumatic response, the response (impact) that a trauma exposure or event leaves on the individual must (1) inflict great distress or serious injury (harm, wound, or damage) to the body or mind, (2) cause at least nine psychological or physiological symptoms as the DSM-5-TR requires*, (3) begin immediately following the event and last for at least three days, and (4) result in clinically significant distress or impaired functioning.

*Note: Clinical presentation of trauma response symptoms varies by individual. In addition, we strongly caution against self-diagnosing. With those things in mind, we are not listing here specific trauma response symptoms identified in the DSM-5-TR. If you are concerned about your mental health or that of a loved one, please reach out to a trained counselor.

All this begs the question: Are exposure and response always tied together? Or are there times when a traumatic event does not significantly impact someone? Are some situations not clinically traumatic, yet they do still cause traumatic responses?

Are trauma exposure and response always tied together?

Not every event (as heartbreaking or overwhelming as it might be) qualifies as a clinical trauma. Likewise, not every event (traumatic or not) leaves a person clinically impacted or impaired.

Given that, there are four ways that trauma exposure and response might present:

• The event/exposure meets DSM-5-TR criteria AND the impact/response does.

• The event/exposure meets DSM-5-TR criteria BUT the impact/response does NOT.

• The event/exposure does NOT meet DSM-5-TR trauma criteria, AND the impact/response does NOT.

• The event/exposure does NOT meet DSM-5-TR criteria, AND YET the impact/response has symptoms similar to trauma response.

Let’s take a closer look at all four.

The event/exposure meets DSM-5-TR criteria AND the impact/response does.

This is where the words trauma, traumatizing, and traumatic can be used freely. Someone can say accurately, I experienced a traumatic event, and I was traumatized by it because I experienced ___.

A scenario that meets the criteria for trauma exposure and response is also where we correctly identify post-traumatic stress disorder (PTSD). Trauma exposure plus trauma response can lead to a PTSD diagnosis. (It’s important to note, though, that not everyone exposed to trauma develops the disorder.)

Turning to your personal experience, you might not consider childhood sexual abuse by your stepfather to be a “sexually violent” event. And the impact might not have created outward symptoms at the time. Yet, we can safely assume that your life was significantly impacted and that you were psychologically impaired enough to need therapy. So it makes sense that your therapist says you were traumatized by the sexual abuse forced on you.

The event/exposure meets DSM-5-TR criteria BUT the impact/response does NOT.

Someone can accurately say, I experienced a traumatic event, but I was able to work through it OK.

This scenario (sometimes known clinically as acute stress disorder) is more common than people might realize. As Dr. Laurel Shaler points out in Reclaiming Sanity, “For most people, recovery from a traumatic event happens naturally and on a timely basis.”

The event/exposure does NOT meet DSM-5-TR criteria, AND the impact/response does NOT.

This situation is not clinical traumatization. Circumstances might be burdensome or undesirable, and they might cause struggle or create challenges. However, they’re part of living in a broken world.

In these cases, someone can accurately say, Life is sometimes terrible and unfair.

The event/exposure does NOT meet DSM-5-TR criteria, AND YET the impact/response has symptoms similar to trauma response.

This scenario does not qualify as traumatic. Nevertheless, because of the impact it can have, many people tend to use the word trauma to describe their experience. Someone can accurately say, I experienced a non-traumatic event, but I was still impacted in a very significant way.

When someone is trying to describe their experience in this scenario, they might use the phrase small t trauma (or little t trauma) as opposed to big T trauma:

• small t trauma: A non-traumatic event that still significantly impacts someone (although the exposure falls outside clinical criteria).
• big T trauma (clinically defined trauma): Exposure or witness to actual or threatened death, serious injury, or sexual violence.

The distinction makes a start in distinguishing clinical trauma from other hardships. However, we try to avoid the phrase small t trauma altogether.

Why? Because stressful events that don’t involve an immediate threat to life, physical injury, or sexual violence aren’t clinical trauma. We believe that using the word trauma outside of its accurate definition can add to confusion about the concept.

As an alternative, we recommend using descriptive words rather than prescriptive words.

What is the difference between descriptive words and prescriptive words?

Descriptive language is just that: It describes, tells, illustrates, articulates, and defines. Descriptive words express experiences, observations, feelings, wants, hopes, and fears. They can better communicate the full depth and breadth of being human and navigating life alongside other humans.

Prescriptive language, on the other hand, relies on labels. It doesn’t explore the range of life experiences, emotions, and feelings. For that reason, prescriptive words limit expression. Using prescriptive words forces events into specific categories without nuanced context — and that’s how they can be clinically misused.

For example, words such as trauma, abuse, toxic, narcissism, depression, panic, and obsessive-compulsive disorder are prescriptive (labels). And again, using those words to describe everyday stress can undermine individuals who do have life-threatening experiences and need professional care.

Want some examples of the difference? Here are three non-traumatic events viewed from both a descriptive outlook and a prescriptive outlook.

Scenario one: Falling in public.

• • Descriptive language: I felt humiliated when I stumbled and fell.
  • Prescriptive language: I was totally traumatized by falling.

Scenario two: Getting in a minor car crash.

• • Descriptive language: That car wreck felt scary and awful.
  • Prescriptive language: That car wreck was so traumatic for me.

Scenario three: Being reprimanded at work.

• • Descriptive language: Getting reprimanded felt deeply embarrassing.
  • Prescriptive language: Getting reprimanded completely traumatized me.

Instead of calling everything trauma, using precise, specific descriptive language conveys what happened and how someone is feeling. Consequently, friends and loved ones have a clearer picture of what someone is enduring. Even more importantly, accurate communication gives therapists and medical professionals objective information that can guide them in creating an effective treatment approach.

Even so, we must never minimize or invalidate the severe impact a non-traumatic event has on someone just because they only use prescriptive language.

Word choice should never prevent appropriate treatment

As we explained earlier, we should never dismiss someone’s pain because of the words they use to talk about it.

Everyone has different coping skills, levels of resilience, and personal histories that affect their sensitivity to distressing events. And so every situation calls for accurate care — whether it’s “normal stress,” “clinically debilitating trauma,” or anywhere in between. That’s where descriptive words can be valuable.

Words are powerful. As society continues to use clinically specific terms in everyday conversation, we encourage people to be as accurate as possible with their words.

What are examples of descriptive words?

When an experience is not life-threatening or sexually violent, use words that describe what happened and how you feel physically, emotionally, mentally, and spiritually. Do the same if an experience was life-threatening or sexually violent, and be confident in calling it trauma.

Here are some descriptive words that can clearly express different life experiences, from traumatic life events that cause harm, to everyday events that may cause hurt (events that might cause frustration or discomfort, yet don’t leave lasting damage). The lists are not complete, of course. We encourage you to use them as starting points to build and refine your descriptive-words vocabulary.